As one would expect from such a diverse group, comparisons were a common topic at the co-located National Medical Home Summit, National Retail Clinic Summit, and Population Health and Disease Management Colloquium this week.
During an opening session, Carolyn Clancy, head of the AHRQ, updated us on some of the comparison work her agency has been doing. Last year’s stimulus bill dedicated a lot of funds ($300 mill directly, more through the Secretary of HHS) to the agency’s work on comparative effectiveness. Read more »
*This blog post was originally published at ACP Internist*
As Harriet Hall has written, psychiatry bashing is a popular media sport. There seems to be a bias against treatment of psychiatric disabilities, and a common claim is that antidepressants are no better than placebo. The New York Times illustrated both the perpetuation of the myth that antidepressants are ineffective, and the increasing and disturbing tendency of major media organizations to confuse the wholesale acceptance of medical press releases with medical journalism.
In Popular Drugs May Help Only Severe Depression The New York Times credulously publicized the findings of a recent study that claimed to show that antidepressants are ineffective in treating mild and moderate depression. Yes, that’s what the study showed, but the study itself is so limited, so fraught with problems, and the conclusions are so misleading that the article is a terrible disservice.
Before we consider what the study showed, let’s think about what kind of evidence we’d need to conclude that antidepressants don’t work. Read more »
Every now and again I like to pick one of the classic research studies on smoking cessation in order to highlight some of the key findings. Today I’m going to focus on the part of the Lung Health Study.
The Lung Health Study is certainly one of the best smoking cessation studies ever carried out, partly because of the comprehensive nature of the assessment and follow-up of its 5,887 participants and partly because it was way ahead of its time in delivering a truly “state-of-the-art” intensive smoking cessation intervention which was compared in a randomized manner to the effects of “usual care”. The Lung Health Study (LHS) was a randomized clinical trial of smoking cessation and inhaled bronchodilator therapy in smokers 35 to 60 years of age who did not consider themselves ill but had evidence of mild to moderate airway obstruction. Read more »
We would all like to live longer. The most promising longevity research indicates that severe calorie restriction might extend life span, but such a diet is difficult to follow. Resveratrol, a phytochemical found in red wine, has been evaluated as a possible way out of the dilemma. When given to obese mice on a high calorie diet, it produced a number of changes associated with improved health, such as increased insulin sensitivity, and it increased survival. Perhaps by taking resveratrol you could eat as much as you want and get fat without suffering the usual consequences. Perhaps you could get the longevity benefits of severe calorie restriction without restricting calories. Read more »
I’ve recently come across AcaWiki, an interesting project focusing on academic research and web 2.0.
Today, representatives from the new nonprofit project AcaWiki announced the opening of their website to the public. AcaWiki’s semantic-wiki based website allows scholars, students, and bloggers to easily post summaries, and discuss academic papers online. All content posted to the site is licensed under a Creative Commons Attribution license.
AcaWiki’s mission is to make academic research more accessible and interactive by creating a “Wikipedia for academic research.” “Cutting-edge research is often locked behind firewalls and therefore lacks impact,” founder Neeru Paharia explains, “AcaWiki turns research hidden in academic journals into something that is more dynamic and accessible to have a greater influence in scholarship, and society.” AcaWiki enables users to easily post and discuss human-readable summaries of academic papers and literature reviews online. AcaWiki also helps users to share and organize summaries through the use of tags and RSS feeds.
*This blog post was originally published at ScienceRoll*
One of the common themes regarding alternative medicine is the reversal of normal scientific thinking. In science, we must generally accept that we will fail to validate many of our hypotheses. Each of these failures moves us closer to the truth. In alternative medicine, hypotheses function more as fixed beliefs, and there is no study that can invalidate them. No matter how many times a hypothesis fails, the worst that happens is a call for more research.
Sometimes this is the sinister and cynical intent of an alternative practitioner—refuse to let go of a belief or risk having to learn real medicine. Often, though, there are flaws in our way of thinking about data that interfere with our ability to understand them. Read more »
A recent research report by Professor Robert Murray (University of Manitoba) and colleagues examined whether nicotine replacement therapy (NRT) may cause cancer. The report was published in the September edition of the journal, “Nicotine and Tobacco Research”, and was based on analysis of the Lung Health Study.
The Lung Health Study recruited 5887 smokers starting November 1986, and 3923 of them were randomly selected to receive an intensive, state-of-the-art stop smoking treatment (group therapy plus nicotine gum). The participants in the original study were followed for 5 years, and 3320 were included in a longer study focusing on lung cancer for another 7.5 years.
The study presents one of the best opportunities of measuring the known exposure to either smoking, or NRT, or both over a 5 year period, as this information was accurately recorded throughout the study.
The study found that 75 participants were diagnosed with lung cancer and 203 with cancer of any type during the follow-up period. Those with the largest cigarette smoke exposure during the study were significantly more likely to suffer lung cancer, but those who used a large amount of nicotine gum were not at any greater risk of suffering from lung cancer or any other cancer examined in the study.
Even though most of the participants were relatively young at enrollment (just under 50) and so had relatively low risk over the immediately following years, around 3.2% of the heaviest smokers developed lung cancer, as opposed to half that proportion in those smoking less. But the amount of use of NRT during the study was not associated with getting cancer.
The results of this study are consistent with the vast majority of human studies, in that they do not find any convincing evidence to suggest that NRT causes cancer.
Murray RP, Connett JE, Zapawa LM. Does nicotine replacement therapy causecancer? Evidence from the Lung Health Study. Nicotine Tob Res. 2009 Sep;11(9):1076-82. Epub 2009 Jul 1.
Demonizing the pharmaceutical industry has become a parlor game for many who enjoy the challenge of shooting at an oversized target. Scapegoating Big Pharma? Now, that takes guts.
Never mind the gazillions they spend on research and development to create tomorrow’s treatments for cancer, arthritis, depression, infectious diseases, heart attacks and strokes. I know that drug industry executives are not all eagle scouts whose mission is solely to save humanity. But, they are not an evil enemy that we need to contain like the “swine flu” pandemic. Sure, they make a profit, and they deserve to. Drugs cost multiple millions of dollars to develop, and most of them never make it to market. Those that do, after years of testing and F.D.A. review, can be summarily shut down when unexpected serious adverse reactions are suspected. In these cases, there may be no actual proof that the medicines were responsible for the ‘side effect’.
I’m not suggesting that we demand airtight proof before issuing drug warnings, only that we beware of what happens if drug company profits can be decimated with the stroke of a pen. Playing rough with the drug companies may appeal to our populist sensibilities, but it can go too far and stifle innovation.
Drug companies need the promise of large profits if they are to take the risks inherent in developing new and novel medicines for all of us. What other business would invest in a new product or technology without the potential for substantial financial gain? Before we advocate price controls for medicines or shortening intervals of patent protection, consider the side effects of this clumsy approach. If we hit Big Pharma too hard, then they will play it safe and churn out lots of drugs that we don’t really need.
Which would you rather they invest in? Another drug for heartburn that is no better than all the others on the shelf, or a vaccine to prevent cancer?
If they succeed in the latter endeavor, I hope they earn hundreds of millions of dollars. This will still be less than the number of lives they will save.
Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.
Senator Ted Kennedy’s death from brain cancer underscores the urgent need for more funding of basic cancer research. Despite the best efforts of a team of top doctors, Kennedy died 15 months after the diagnosis of a malignant brain tumor called glioblastoma. Over the past ten years, some progress has been made against this deadly illness and the silhouettes of some promising new approaches are becoming visible. But our treatment options remain woefully inadequate.
With over 560,000 cancer deaths each year, that comes to less than $10,000 in research spent for every cancer death. That simply is not enough money spent on a problem that strikes almost 1.5 million Americans each year and causes nearly one of four deaths.
Research for certain cancers is especially under funded. Earlier this year, I helplessly watched a dear friend and patient die from esophageal cancer, both of us knowing that only 22 million dollars each year - about $1,500 per death - was being spent by the NCI on the disease annually. One reason is that patients with esophageal cancer don’t have a strong advocacy group to push for their fair share of the funding pie. Lung cancer, which tops the list of cancer killers in America, only gets about $1,500 per death. At the top of the list based on research spending per death are cervical cancer (about $19,000), breast cancer (about $14,000) and brain cancer (about $12,000).
Click here for a chart that I compiled with the help of statisticians at the NCI that breaks down government spending on the top cancers.
Of course, there shouldn’t have to be a competition among cancer advocacy groups. There should be adequate funding of basic medical research to help discover the underlying cellular mechanisms that many cancers share and that hold the key to prevention, early diagnosis and effective treatment. But there’s not enough money for our young researchers. In 1980, almost 25 percent of first independent government grants went to scientists under age 35; that figure has plummeted to only 4 percent as the first-grant age rose from 34 to 42.
Faced with increasing competition for shrinking dollars, many of our best and brightest are considering other careers.
My cancer patients desperately need a bailout. The best way to increase our spending on cancer research responsibly is through health care reform. The Institute of Medicine has estimated that about 20 percent of the annual $2.5 trillion in health care costs is unnecessary. That’s $500 billion annually or 100 times the current budget of the National Cancer Institute. There could be no better tribute to Senator Kennedy or wiser investment in our own futures than to fix a broken system that threatens to bankrupt us while inadequately addressing one of our most devastating health problems.
For this week’s CBS Doc Dot Com, I take you behind the scenes to an edit bay at the CBS Broadcast Center in New York. I talk to Dr. Henry Friedman, an expert on brain cancer. He is co-deputy director of the Preston Robert Tisch Brain Tumor Center at Duke University Medical Center. In addition to hearing about the latest treatments for the disease, you’ll see the secret behind how we do long-distance interviews for the CBS Evening News with Katie Couric.
The individual in the photo is not displaying his newly acquired gold tooth bling, but rather something more precious: the first fully functioning 3D organ derived from stem cells, described in PNAS as “a successful fully functioning tooth replacement in an adult mouse achieved through the transplantation of bioengineered tooth germ into the alveolar bone in the lost tooth region.”
More from The Wall Street Journal:
Researchers used stem cells to grow a replacement tooth for an adult mouse, the first time scientists have developed a fully functioning three-dimensional organ replacement, according to a report in the Proceedings of the National Academy of Sciences. The researchers at the Tokyo University of Science created a set of cells that contained genetic instructions to build a tooth, and then implanted this “tooth germ” into the mouse’s empty tooth socket. The tooth grew out of the socket and through the gums, as a natural tooth would. Once the engineered tooth matured, after 11 weeks, it had a similar shape, hardness and response to pain or stress as a natural tooth, and worked equally well for chewing. The researchers suggested that using similar techniques in humans could restore function to patients with organ failure.
Update From Haiti: Despair Sets In And Women Consider Suicide
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